Youth Sports Safety Week Youth Sports Safety Week offers something for everyone! There are opportunities … Read More
Youth Sports Safety Week Youth Sports Safety Week offers something for everyone! There are opportunities … Read More
For Immediate Release CONTACT: Amanda Maselli New Hampshire Orthopaedic Center 603.883.0091 nhoc.com KNEE REPLACEMENT … Read More
© 2015 New Hampshire Orthopaedic Center
By Kathleen Hogan, M.D.
Nothing lasts forever. Articular cartilage allows our joints to move freely without pain. As that cartilage wears out or becomes damaged, arthritis develops. If the resulting pain and deformity from arthritis becomes severe, many joints can be replaced, usually with metal and plastic implants. However, these artificial joints wear out with time and use.
Surgeons expect that the hip and knee replacements that we are implanting today may last twenty years or longer. There are many factors that impact longevity. Patient weight and activity level are important factors. Excessive body weight is a risk factor in the development of arthritis and can contribute to early wear and failure of orthopedic implants. High impact activities such as running and jumping place excessive loads on the components.
When joint replacements were first being developed, one of the biggest problems was to find a material that was durable with a low frictional coefficient, with a low wear rate that did not cause an adverse reaction in the body. Teflon was tried, but very quickly failed. It was slippery, but not durable, and the resulting wear particles resulted in excessive inflammation. Metal on metal implants were also used but also had problems with implant design and manufacturing problems. Eventually, polyethylene, which has many industrial uses was discovered to be an excellent bearing surface. According to legend, Sir John Charnley, the inventor of the modern hip replacement, first implanted polyethylene in his own leg to ensure that it would not cause an adverse reaction in the body!
Since polyethylene was first used in hip replacements in the 1960’s, it has been adapted for use as a bearing surface in knees, shoulders, ankles, and fingers. Modifications have been made to further increase its durability and reduce wear rates. An ultra high molecular weight polyethylene can be used to increase the strength of the material. Most polyethylene used in joint replacement is now highly cross linked by treating the plastic to promote the formation of bonds between carbon fibers. This process increases the wear resistance of the plastic but can diminish strength. The increased durability from cross linking can be diminished, however, if the polyethylene becomes oxidized. The overall wear rate of polyethylene depends on many different patient and implant factors.
When an implant begins to wear out, the wear particles from the polyethylene can cause inflammation. This inflammation can loosen the bond between the joint and the bone. It can also cause pain and instability. If significant wear occurs, a revision surgery may be required.
How long will a joint replacement last? The estimated annual failure rate of hip and knee replacements is 0.5%. Approximately 80% of hip and knee replacements performed 20 years ago are still functioning well. It is expected that joints replaced today will last at least that long and improvements in implant design may further increase that longevity. Patient weight and activity levels have increased, however, and people are having joints replaced at younger ages. For this reason, it is still recommended to get follow up radiographs of joint replacements every few years to ensure that the joint is continuing to function well.
What can you do to increase the longevity of your hip or knee replacement? Although moderate activity is encouraged, it is recommended to avoid high impact activities such as running. Keep your weight within recommended limits. Avoid lifting heavy weights (over 50 lbs) with your job or at the gym. Talk to your surgeon if you have questions about activity after surgery or if you have concerns about your joint replacement.
By Anthony R. Marino, MD
Stress fractures are tiny cracks in bone. Runner’s often have stress fractures in the weight bearing bones of their lower legs and feet. Stress fractures are serious running injuries that pose a significant long term limitation and require considerable time off.
The most common cause of stress fractures is overtraining. Over time your body will respond to the stress of your work-outs. If you increase the intensity, duration or frequency of running too quickly, your body cannot repair itself fast enough and a micro failure occurs. Generally stress fractures are not something that you can run through and a significant time off from running is recommended. You should not begin rehabilitation until after you have seen a professional and received a stress fracture diagnosis.
Avoiding all impact exercises is very important. Cross training by cycling, pool running and swimming is recommended. You should modify your activity if you feel pain. Pool running and swimming are some of the best exercises you can do.
Runners often find it hard to believe that you can keep your fitness at a very high level with cross training or pool running while you allow the stress fractures to heal. Elite athletes who have cross trained while taking extensive time off due to stress fractures have returned to pre-injury performance levels.
When you return to running, you must start very slowly. Then, you very gradually increase your mileage over a long period of time.
Eating disorders increase the risk of stress fractures. When young runners are diagnosed with stress fractures they should be evaluated for possible eating disorders and treated if they are found.
By: Kathleen A Hogan, MD
Weight matters to all of us, whether we’re size 6 or 16. Regular exercise can help with weight maintenance and loss, especially when combined with a healthy diet. Exercise also elevates mood, improves cardiovascular health, and increases bone density. Inactivity on the other hand, contributes to the development of obesity, heart disease, and diabetes. How Much Time Do I Need to Exercise?
People frequently wonder “How much time do I need to commit to exercising to get these benefits?” And “How it is possible to start an exercise program when my joints hurt?”
There is increasing scientific evidence that 30 minutes a day of vigorous activity may be just as beneficial to overall health and fitness levels as an hour or more of activity. The American College of Sports Medicine recommends 150 hours of moderate activity a week. This can be accomplished in only 30 minutes per day for 5 of 7 days.
Shorter periods of activity are as effective as a prolonged workout. Plus, people are more likely to continue exercising and feel less fatigued when they stick to 30 minutes per day. Strength and flexibility exercises should be performed twice weekly in order to maximize health benefits. In addition, balance and agility exercises can help to prevent falls in older adults. Strengthening the core muscles can help to decrease the incidence of back pain.
Every day in clinic I have patients tell me that they couldn’t possibly exercise because their joints hurt or because they are too overweight. That is simply not true. Many activities can be modified to minimize the stress on the joints.
The pool is an excellent alternative to land based activities. An exercise bike, elliptical trainer, and rowing machines all minimize joint stresses compared to running. Upper and lower body weight training is possible even for those who have arthritis in their hips or knees. Strength training builds muscle and increases bone density. Strong muscles can help decrease stress on joints.
If you do not routinely exercise or lift weights, you can easily injure yourself. I often recommend starting with a physical therapy program with a goal of designing a home exercise program based around specific joint ailments. But this only works if you commit to following through with the exercises you learn in therapy.
How sedentary are you? I would suggest downloading a free pedometer app for your phone and keeping track of the number of steps you take daily for a week. A reasonable goal is 10,000 steps (5.2 miles) per day. If you have a desk job or sit most of the day you will likely take far fewer steps unless you add additional activities to your day. Sometimes having a reminder of just how sedentary one has been can be the encouragement needed to increase activity. Gradually work towards the very reasonable goal of doing something physically active for 30 minutes each day. Make sure you talk to your doctor about starting any exercise program, especially if this is new to you.
By: Jake A. Motha, DPT
Have you fallen in the past year? Do you feel unsteady when standing or walking? Do you worry about falling? If you answered yes, you are not alone. In fact, one out of three older adults age 65 or greater will fall within the year. It is no surprise the older we get the higher the risk of falls.There is a multitude of factors that can contribute to a fall and there are several steps you can take to mitigate that risk.
In 2013, 2.5 million people were treated in emergency rooms with fall related injuries.Consequences of such events can be detrimental to your health and include serious injuries. Approximately 30 percent of people who fall suffer moderate to severe injuries such as: lacerations, fractures, traumatic head injuries, and can even contribute to early death. With falls being the most common cause of traumatic brain injury,it shouldn’t be a shock to learn that many people develop a fear of falling, and subsequently reduce their activity levels.This can contribute to a sedentary lifestyle, lower physical fitness levels and actually increase the risk of falling.
There are several steps you can take to reduce the risk of falling. Exercising regularly will help to maintain strength and balance. Programs such as Silver Sneakers© and Tai Chi are commonly offered to promote health and fitness.You can work with a physical therapist to develop an independent home exercise program to focus on leg strength and balance. Exercise, along with calcium and vitamin D supplementation, can ensure strong healthy bones and reduce the risk of osteoporosis, as it has been proven that strong bones can greatly reduce your risk of falls.
Medications, with their many side effects, can contribute to dizziness leading to a fall. Taking multiple medications can exacerbate their adverse effects. Meet with your doctor to discuss reducing any unnecessary medications. Have your eyes checked yearly and avoid bi and multi-focal lenses which can skew ones vision when walking, especially on uneven surfaces. You can also make environmental modifications to your home to reduce tripping hazards. As we age our night vision is often impaired. Ensure that you have proper lighting installed, use nightlights to illuminate hallways. Avoid the use of scatter rugs and make sure cords and clutter are removed from walkways. Installing grab bars near toilets, showers, tubs, and railings on both sides of the stair case can improve stability during transitional movements.
Falls can be unpredictable and while nobody anticipates a fall, most can be avoided. Taking early and preventative action will help to reduce the risk of serious bodily injury. Do not wait until the damage is done. Contact your doctor or physical therapist today to learn more about how you can prevent falls for you and your loved ones.
New Hampshire Orthopaedic Center has recently introduced a new bone heatlh program. The program includes evaluating and treating patients over 50 years of age who have sustained a fragility fracture due to underlying osteoporosis. A fragility fracture occurs after a low impact fall from a standing height or less. Healthy bone should be able to withstand the forces of a standing height fall without a fracture occurring. When bones fracture after a fall from a standing height a bone health evaluation is recommended. Our bone health program goes beyond treating a patient’s existing fracture by ensuring the underlying cause of the fracture is identified and treated as well.
Patients will be asked to have a bone mineral density test called a DXA scan prior to their bone health evaluation. The DXA scan helps determine strength of bone and risk of future fracture. Our Bone Health Specialist, Dagan Cloutier, PA-C, will use the DXA results to determine if patients need a further work-up including laboratory tests. Laboratory tests help determine if patients have secondary osteoporosis or osteoporosis caused by an underlying medical condition. According to Dagan, his goal of the program is “to provide patients with education and potential treatments to help reduce their risk of a future fracture.”
By: Kathleen A. Hogan, MD
Everyday when you get out of bed, your knees crack. They hurt when you go up and down stairs. You have tried taking ibuprofen and tylenol but that no longer seems to work. You mention your knee pain to your primary care doctor who gets X-rays and tells you that you have arthritis and recommends that you see an orthopaedic surgeon. But now what? Who do you go see? How do you know who is “the best” doctor for you? This article will help you understand how to choose an orthopaedic specialist.
Your primary care doctor will likely give you recommendations on who to see. Do not be afraid to ask some questions. Why are you being sent to this doctor? Is it because that doctor works for the same hospital group or organization? Have other patients gone to this surgeon with good results? Is this doctor a specialist in this particular problem? Are they board certified and fellowship trained?
Board certification means that the doctor has passed several tests dictated by the specialty field they practice in. Most hospitals require their doctors to be board eligible or board certified. Fellowship training means that the physician has completed additional training in a certain specialty. In orthopaedics, fellowship training is available in specialties of the spine, hand, joint replacement, sports medicine, trauma, pediatrics, and oncology. Most fellowship-trained surgeons focus most of their practice on one specialty.
The internet is full of good and bad information, so be cautious about relying too much on reviews posted on the web. However, a physician’s web page can give you some basic information on the physicians credentials and specialties as well as office locations.
But picking the “right” surgeon for you often entails knowing more than just their resume. Friends and family members who have visited orthopaedic surgeons will often be more than happy to give you advice on which doctors they like best and why. You may find that one surgeon always runs behind in the office but spend a lot of time listening and explaining things? Another may spend less time talking and run their office more efficiently? These are helpful things your friends can tell you, that the internet can not.
Also, many of the hospitals sponsor informational seminars where you can listen to presentations on topics such as knee and hip replacement and ask questions in an informal setting. This is a great way to find out information about the surgery you may be considering and to learn more about a surgeon.
Who is the “best” orthopaedic surgeon? It is the physician who will treat you with respect, answer your questions, and make you feel comfortable with your care and treatment plan. You should never feel pushed into having surgery. With the exception of a broken bone, many orthopaedic problems such as knee and hip pain can be treated successfully without surgery. Do not be afraid to seek out a second opinion. If you do require surgery, you need to feel confident that your surgeon will take excellent care of you.